Term
| What are the signs and symptoms of Diabetes? |
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Definition
| r/t HYPERGLYCEMIA polyuria, polydipsia, ketonuria (ketone bodies in urine from HYPERglycemia), weight loss |
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Term
| Describe the pathology of Type I Diabetes? |
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Definition
| Pancreatic beta cells destroyed by autoimmune dysfunction. |
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Term
| Describe the pathology of Type II Diabetes. What are the 3 target tissues of insulin? |
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Definition
| Capable of secreting insulin however: 1. release is NOT coupled tightly with plasma glucose; insulin is DELAYED and peak output is low 2. Target tissues [liver, muscle, fat] become insulin resistant. |
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Term
| What are the 3 characteristics that are REDUCED in insulin resistant tissue? |
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Definition
| Receptors: reduced #, reduced binding, reduced responsiveness |
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Term
| What are the short term complications of diabetes? Which type of diabetes sees more of these short term complications? |
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Definition
| HYPERglycemia (ketoacidosis) and HYPOglycemia (ketonuria)--more common in Type I Diabetes. |
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Term
| What are the long term complications of Diabetes-- (3) MACROvascular and (6) microvascular: |
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Definition
| r/t HYPERGLYCEMIA: MACROVASCULAR (HTN, heart disease, stroke) MICROVASCULAR: blindness, kidney damage, neuropathy, gastroparesis, amputations, ED |
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Term
| What is the primary goal of diabetes treatment? |
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Definition
| Preventing LONG TERM complications (esp CVD, retinopathy, nephropathy and amputations) |
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Term
| What are the benefits and drawbacks of tight control? How many times is insulin given in each? |
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Definition
| TC decreases mobidity and mortality but can cause HYPOGLYCEMIA. Conventional therapy gives a Regular+NPH shot before breakfast and again before dinner and is the same everyday. |
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Term
| What are the metabolic actions of insulin? |
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Definition
| Glucose-->Glycogen, FFA-->Triglycerides, AA--->Proteins, cellular uptake of K |
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Term
| What are the S/Sx of HYPOglycemia (BG < 50)? |
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Definition
| Sweating, nausea, Tachycardia, palpations, headache, confusion, drowsiness, convulsion, coma, DEATH |
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Term
| What are the sources of insulin? |
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Definition
| Recombinant DNA and beef/pork pancreas |
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Term
| What are the different routes/types of administration? |
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Definition
| SC injections (syringe/needle, pen, jet injectors); Inhalation, SubQ infusion pumps (implantable), IV Infusion |
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Term
| Three sites of injection into the subQ fat are: |
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Definition
| Upper arm, abdomen and thigh |
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Term
| Three insulin syringe sizes |
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Definition
| 1cc, 1/2 cc and 1/3 cc (100u, 50u, 30u) |
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Term
| When is need for INSULIN increased? |
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Definition
| Stress, illness/infection, obesity (adipose makes cells resistant to insulin), pregnancy after 1st trimester |
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Term
| When is the need for insulin decreased? |
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Definition
| Exercise and pregnancy 1st trimester. |
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Term
| What are the MOA of Biguanides? |
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Definition
| Decreases glycogenolysis and glu absorption in the gut, and increases INSulin sensitivity on target tissues. GLYCEMIC CONTROL, PREVENT T2D, GESTATIONAL D, POLYCYSTIC OVARY SYNDROME [decreased appetite, nausea, diarrhea, lactic acidosis] |
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Term
| What are the MOA of Sulfonylrueas? |
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Definition
| Promote insulin release from pancreatic cells {blocks ATP sensitive potassium channels causing Ca++ influx}, 2nd gen much more potent and have fewer d-d interactions. T2D ONLY. [hypoglycemia, cardiovascular toxicity |
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Term
| Can you mix a clear with a cloudy insulin? |
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Definition
| YES, NPH is cloudy and the only longer onset insulin you can mix with short duration insulins (which are clear) |
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Term
| What do you have to do to NPH before you draw it? |
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Definition
| slowly roll it btw your hands to gently agitate. |
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Term
| What are the effects of combining oral hypoglycemics and alchol? |
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Definition
| it potentiates the hypoglycemic effects |
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Term
| What are the effects of Beta Blockers on the outcome of taking Sulfonylureas or Biguanides? |
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Definition
| Beta blockers diminish the effects by supressing insulin release, they can also mask the tachycardic sx of hypoglycemia. |
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Term
| What are the MOA of Thiazolidinediones (TZD's/Glitazones) |
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Definition
| Decrease insulin resistance. {T2D only}. Reduces insulin resistance by activating PPAR-gamma receptors turning on insulin responsive genes in DNA and regulating CHO and Trig. metabolism. EXPAND BLOOD VOL, EDEMA, risk of HF. |
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Term
| MOA of Alpha-glucosidase inhibitors |
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Definition
| Delays ABS of CHO's in gut, causes cramping, gas, diarrhea--doesn't depend on inlsulin. |
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Term
| What are the 5 treatments for Diabetic ketoacidosis (DKA)? |
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Definition
| Insulin replacement [normalization of GLU levels], bicarbonate, water and Na and K replacement, normalization of GLU levels |
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Term
| What are two new injections for diabetes and their MOA? |
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Definition
| Byetta (adjunctive therapy to improve glycemic cntrl in T2D [Hypoglycemia, GI effects]), Pramlintide [supplement to mealtime insulin [hypoglycemia]} |
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Term
| What is the role of GLUCAGON in the management of diabetes? |
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Definition
| Used IV when Insulin overdose. |
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